Edema, lung volume and lymphedema

edema pitting scale 1+

indentation is barely detectable

edema pitting scale 2+

slight indentation visible when skin is depressed, returns to normal in 15s

edema pitting scale 3+

deeper indentation occurs when pressed and returns to normal within 30s

edema pitting scale 4+

indentation lasts for more than 30s

Diaphragm resting position with SCI

lower resting position → decreased inspiratory reserve

• when upright → lower → decreased IR

• when supine → better position of diaphragm

What may be beneficial for abdominal support for a SCI pt who lacks abdominal muscle control?

Abdominal binder, provides support

FEV1

forced expiratory volume in 1s of FVC

FEV1 normal value

>70% of FVC exhaled within 1s

• FEV1/FVC x 100 > 70%

FEF

Forced expiratory flow rate 25—75% of exhaled volume on FVC exhalation curve

• more specific to smaller airways, dramatic changes with disease compared to FEV1

What is seen here?

Obstructive disease LVs

What is seen here?

Normal LVs

ventilation

movement of air in and out of the lungs

respiration

gas exchange within the lungs

Normal PaO2

90—100 mmHg; 98—100% SpO2

Abnormal PaO2 warranting supplemental O2 consideration

55 mmHg; 88% SpO2

Hypoxemia

PaO2 < 80mmHg

Low level of O2 in arterial blood

Hypoxia

Low level of O2 in tissue

Normal pH

7.35—7.45

If normal → compensated

Normal PaCO2

35—45mmHg

if normal → metabolic

Normal HCO3-

22—26 mEq/L

if normal → respiratory

What is it called is all 3 ABG measurements are abnormal?

Partially compensated

Decreased pH, increased PaCO2, normal HCO3-

Respiratory acidosis

Increased pH, decreased PaCO2, normal HCO3-

Respiratory alkalosis

Decreased pH, normal PaCO2, decreased HCO3-

Metabolic acidosis

Increased pH, normal PaCO2, increased HCO3-

Metabolic alkalosis

Treatment for respiratory acidosis

Ventilation

Correct electrolyte imbalance

Treatment for respiratory alkalosis

Increase CO2 retention via rebreathing, sedation

Treatment for metabolic acidosis

Correct electrolyte imbalance; use NaCO3 for severe acidosis — pH < 7.2

Treatment for metabolic alkalosis

Administer potassium chloride

COPD, respiratory failure, GBS, MG, respiratory center depression, CNS lesions, hypermetabolism, sepsis, burns are causes for …

Respiratory acidosis (causes)

Hyperventilation, increased excretion of CO2 by the lungs, pregnancy, high altitude, PF, ascites, scoliosis, CHF, anxiety and severe pain are causes for …

Respiratory alkalosis (causes)

Acid retention, deficit of base in the blood stream are causes for …

Metabolic acidosis (causes)

Abnormal loss of acid or excess accumulation of bicarbonate are causes for …

Metabolic alkalosis (causes)

Ideal ventilation (V) and perfusion (Q) are seen as what V and Q ratio?

1:1

Dead space

Well ventilated but no gas exchange (respiration) occurs

• anatomical: blood and O2 present, vessels wall too thick; no exchange ie: nose, trachea and bronchi

Physiological dead space

Not enough blood flow (perfusion)

• PEs

• Air that doesn’t take part in gas exchange

Shunt

Complete atelectasis of respiratory unit, allows blood to travel through pulmonary capillaries without gas diffusion

• pneumonia, PE, alveolar collapse

Class 1 lymphedema garment compression …mmHg

20—30mmHg

Class 2 lymphedema garment compression …mmHg

30—40mmHg

Class 3 lymphedema garment compression …mmHg

40—50mmHg

Class 4 lymphedema garment compression …mmHg

50—60mmHg

Class 1 lymphedema garment compression indications

• Mild Lymphedema

• Typically UE, not LE

• Fragile skin or elderly

Class 2 lymphedema garment compression indications

• Stage II UE lymphedema

• Minimum compression of LE lymphedema

Class 3 lymphedema garment compression indications

• Rarely used for UEs

• Typically for stage II LE lymphedema

  • high intensity, repetitive activities

Class 4 lymphedema garment compression indications

• Rare

• Only for LE lymphedema

• Custom made

Left: chap8 + pg 204—208